    <div class="container">
      <div class="bg-putih">

        <div class="jdl-page">
          <?php echo isset($judul)?$judul:'<font color="#ccc">Judul Belum Diberikan</font>'; ?>
          <div class="clearfix"></div>
        </div>

        <?php echo form_open('pasien_kunjungan/add', array('class' => 'form-horizontal', 'role' => 'form', 'id' => 'form')); ?>
        <div class="form-group">
          <label class="col-xs-2 control-label">Nama Pasien</label>
          <div class="col-xs-10">
            <script type="text/javascript">
             $(document).ready(function() {
              $("#pasien").select2();
            });
           </script>
           <select id="pasien" class="js-example-basic-single js-states form-control" name="pasien">
            
            <?php  
            $klpk_getter = $this->db->get('pasien');
            $res_klpk_getter = $klpk_getter->result_array();
            foreach($res_klpk_getter as $klkpk_obat):
              ?>
            <option value="<?php echo $klkpk_obat['KdPasien'] ?>"><?php echo $klkpk_obat['Nama'] ?></option>
            <?php
            endforeach;
            ?>
          </select>
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">TD</label>
          <div class="col-xs-10">
             <input type="text" name="td" class="form-control input-sm" placeholder=""> 
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">Suhu</label>
          <div class="col-xs-10">
            <input type="text" name="suhu" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">RR</label>
          <div class="col-xs-10">
            <input type="text" name="rr" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">HR</label>
          <div class="col-xs-10">
            <input type="text" name="hr" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">Keluhan</label>
          <div class="col-xs-10">
            <textarea name="keluhan" id="keluhan" class="form-control input-sm" rows="3"></textarea>
          </div>
        </div>
        <div class="form-group">
          <div class="col-xs-offset-2 col-xs-10">
            <button type="submit" class="btn btn-primary btn-sm">Simpan</button>
            <button type="reset" class="btn btn-default btn-sm">Kosongkan</button>
          </div>
        </div>
        <?php echo form_close(); ?>

        <div class="clearfix"></div>
      </div>
    </div> <!-- /container -->

    <script>
    /* $("#form").validate({
      rules: {
        nama: {
          required: true,
          minlength: 3
        },
        ket: {
          required: true         
        }
      }
    });*/
    </script>